Provider Demographics
NPI:1225493349
Name:VISION WELLNESS, INC
Entity Type:Organization
Organization Name:VISION WELLNESS, INC
Other - Org Name:LIFETIME EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-871-9273
Mailing Address - Street 1:4765 VILLAGE PLAZA LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6676
Mailing Address - Country:US
Mailing Address - Phone:541-342-3100
Mailing Address - Fax:541-342-6153
Practice Address - Street 1:4765 VILLAGE PLAZA LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6676
Practice Address - Country:US
Practice Address - Phone:541-342-3100
Practice Address - Fax:541-342-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3639ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty